The Tennessee bill heading to Gov. Bill Haslam’s desk that would criminalize drug use in pregnant women puts even women in medication-assisted treatment (MAT) in jeopardy, according to advocates. Just as ADAW was going to press, we got a call from Rodney Bragg, assistant commissioner of the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS). We asked him if it was true that under the bill, which the TDMHSAS worked on, a new mother who was taking prescribed methadone or buprenorphine as part of a treatment program could be arrested if her baby had neonatal abstinence syndrome (NAS).

“That’s not true; they won’t be arrested,” he said at first. But what if a hospital reported them — as is required in Tennessee? “They could be arrested,” he said. “But the bill says that if a person is in treatment and continues in treatment,” that person is excepted from the provisions, he said. The language of the bill actually indicates that the woman must have “completed” a program. Would continuing taking maintenance medication be viewed as completing a program? “As long as they’re still on it,” said Bragg.

No authority over prosecutors

But the bottom line is this: The Department of Health and TDMHSAS have no say over what an individual prosecutor decides to do. “We have no authority over the prosecutors,” Bragg admitted. “If [the women] are arrested, they could go to jail. But it’s only a simple assault misdemeanor, and if they do bond, they can get out and work with probation.”

Women in MAT who are simply following medical treatment do not necessarily want an arrest record or to be on probation, and may decide instead to terminate their treatment — or their pregnancy. Bragg acknowledged that this could happen. “How this ends up living out, we’re not sure,” he told ADAW.

The TDMHSAS has already gotten the bill toned down, he said. “We knew this was brewing,” said Bragg of the bill. The original intention of the sponsor was “to get somebody arrested so they could get into drug court,” he said. “So it started off as a felony arrest. We helped get it down to a simple assault misdemeanor.”

There were some questions that Bragg couldn’t answer. “I don’t know what’s going to be done to get them to stay in treatment,” he said of pregnant women on MAT. “Do we want women to be arrested? Absolutely not.”

Research on detox during pregnancy

While acknowledging that medical professionals and organizations urge pregnant women who are opioid-dependent to go on methadone or buprenorphine, and if they are in MAT to stay on it, because withdrawal is so harmful to the fetus, Bragg said that newer research needs to be done. “We have a number of doctors in Tennessee who will detox women in the first and second trimesters,” he said. “It’s not recommended but it was done by a very small study.” So the Tennessee Department of Health is sponsoring research to “have some universities” look into whether or not women have to stay on MAT during pregnancy.

The Department of Health does not endorse either keeping pregnant patients on MAT or detoxing them, said Bragg. “We expect treatment providers to serve the pregnant women in the way the medical doctor sees as most important,” he said. The current practice is based on research, he admitted, but he said it’s “old research; it’s not the latest research.” The contracts for the research are out already, and reports are due back in a year, he said.

Governor Haslam has not asked Bragg for his input on the veto decision, said Bragg.

The current bill, if not vetoed, would take effect this July.